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What we learned from Nigeria's polio victory

Polio vaccination workers in Nigeria. The country has not registered a single new case of polio for a full year. Photo by: evanmwheeler / CC BY-SA

The recent confirmation that Nigeria has not registered a single new case of polio for a full year has been hailed as a huge milestone in the decades-long battle against the crippling disease, and cited as an example of public and private development partners truly working together to achieve a common global health goal, with full local ownership.

It definitely wasn’t easy.

Vaccination teams in Nigeria had to overcome myriad obstacles, among them fierce resistance to the vaccine drug among religious groups that claimed it caused infertility, the threat of armed militias like Boko Haram or entire shipments of vaccines spoiling due to lack of refrigeration from the erratic electrical supply in remote rural areas.

The main operational challenge was that too many children were being missed because the vaccination campaigns were not reaching them, recalled Oliver Rosenbauer from the World Health Organization’s Global Polio Eradication Initiative.

“Vaccinators were operating blindly. They would show up at a health clinic and they would not know if there were enough vaccines or enough ice packs,” he told Devex. “Often they lacked detailed maps of the areas they had to cover — if they had maps at all. It was very easy to miss entire areas.”

Rosenbauer compared this situation with previous WHO-led polio vaccination campaigns in India, where vaccination campaigns were planned down to the last child in the most remote village, a multi-stakeholder effort that successfully helped make India polio-free in 2014.

Engage community leaders

Nigeria’s anti-polio efforts received a huge boost in 2011, when newly elected President Goodluck Jonathan vowed to wipe out the disease within three years and turned the campaign into a whole-of-government effort that would finally tackle popular resistance to the vaccination campaigns, making polio as much of a priority as killer diseases like malaria or measles.

Jonathan’s push almost immediately achieved results at the federal and state levels, but vaccinators were struggling to make breakthrough at the local level.

How can polio infrastructure be harnessed for measles eradication? In this guest commentary, Dr. Steve Cochi, senior adviser, Global Immunization Division, U.S. Centers for Disease Control and Prevention, explains why transitioning from polio eradication to measles eradication is both an opportunity and an obligation.

“We soon figured out that even with full government support, we could not reach certain communities without engaging traditional leaders,” Oyewale Tomori, chairman of the expert review committee on polio eradication in Nigeria, told Devex. “As soon as we brought them on board with help from NGOs and some politicians, popular resistance to the vaccination campaigns disappeared.”

Tomori, who recognized that neglecting such powerful figures within these communities was probably the biggest mistake, explained that the traditional rulers soon became solid partners, ensuring that no family under their leadership would refuse to have their children vaccinated, and providing security.

His advice to other global health partners: “Get the local community to own the program, explain to them that this is for you. Talk to them, ask them what they need, and give it to them.”

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Don’t assume doing good is enough

Sometimes, though, certain communities would not fully understand why make such a fuss about polio when their children were dying of other diseases, including diarrhea. The government launched a massive television and radio advertising campaign to inform the public, and vaccinators would bring sweets and toys to entice the kids.

“The children would be attracted to them like they were the Pied Piper,” said Dr. Tunji Funsho, chairman of the Nigeria National PolioPlus Committee and head of Rotary International’s anti-polio program in the country.

The candy, though, was not part of Rotary International’s initial plans, and one of many lessons learned for the organization along the way, including that doing good is not enough.

“One of the things we were wrong to assume was that because vaccination is a good thing, everyone would be on board. We did not prepare the ground enough for people to appreciate that this is good for them and there is no harm,” Funsho told Devex. “Next time we will come out with a huge program educating the people, even if we know it’s good for them, so when we start we don’t face the same obstacles.”

It was definitely not a mistake, he noted, to train local health workers and develop a rapid response network to fight polio, as that structure was already in place in late 2013 and helped prevent the spread of Ebola across Nigeria.

“One good thing is that the structures we have created will help other vaccination programs and even fight epidemics,” Funsho said.

Keep the momentum

Slowly but surely, polio cases started to drop in Nigeria, until the last reported case was in July 2014. However, the country — and the whole of Africa — can only be declared completely polio-free if no new cases are registered for two more years, until 2017.

To achieve that goal, vaccination campaigns must continue.

“The progress has been tremendous, and needs to be maintained [because] polio can come back quickly [even if] Afghanistan and Pakistan seem far away,” Rosenbauer explained. “If you don’t maintain strong vaccination programs, the disease will find a way to come back, we’ve seen it time and again.”

The next front in the global struggle against the disease is now in Asia, and the WHO official stressed that eradicating the disease there — once and for all — is the only way to ensure polio will never return to Africa.

“That’s where the fire is, and it’s from there that the fire will spread to anywhere in the world, including Nigeria,” Rosenbauer said.

About the author

Carlos Santamaria is a multimedia journalist and editor based in Manila. A former Devex associate editor, he has over a decade of experience working for international media outlets such as Reuters, Associated Press, Xinhua and EFE in Spain, China, the Philippines, Thailand and the United States, and has covered major crisis situations on the ground in Myanmar and Japan. Carlos is currently an editorial and communications consultant with the Asian Development Bank.

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